211795 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 143001 Page 1 of 1
ONE CIVIC SQUARE INDIANA ASSOC OF CITIES&TOWNS CHECK AMOUNT: $295.00
CARMEL, INDIANA 46032 CONFERENCE REGISTRATION
�? 200 S MERIDIAN ST,SUITE 340
INDIANAPOLIS IN 46225 CHECK NUMBER: 211795
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4357004 295 . 00 EXTERNAL INSTRUCT FEE
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2 012 IACT ANNUAL CONFERENCE & EXHIBITION REGISTRATION FORM
Pre-Registration Deadline: September 18 ,..
Full Name Cit
_ i'
y or Town/State/Zip /� �qt �, 9
?, Preferred Name for Badge Phone
Title / Email r '
First Time Attendee? OYes O'No Spouse/Guest Name t �/I
Municipality/Company �n �f-, tl Special Needs and Dietary Restrictions
Council President's Name CJ ix:�-�
ra I -
z'.
Address
J ) _Fe�q
Method of Payment ,
«� •
Registration Fee w
` trra On/Before After EnterAmount / -
t ;T; 9/18 9/18 f]lCheck El Visa ❑MasterCard Cl Discover
at 7
N Member Municipal Official(Population $295 $350 ° Check#(Payable to TACT)
greater than or equal to 1,000) 6) I- `
Cardholder Name
Member Municipal Official(Population $175 $225
less than 1,000) Credit Card Number
Associate Member $295 $350 Expiration Date
Spouse/Guest* $175 $225 3-digit Verification Code
Non-Member $425 $475 Billing Address J
Municipal Day(Wednesday Only) $225 $275 City or Town/State/Zip
a
Total Amount Due: $ '' Signature of Cardholder
*The spouse/guest registration fee is restricted to those who are not municipal officials and who have no professional interest at the conference. The '
fee includes admission to all conference events,the exhibit hall,meals and participation in the spouse/guest program. $'
Please Check the Conference Events You Plan to Attend (For planning purposes only)
0TUESDAY, ❑TUESDAY, n• f"'•
OTUESDAY, TUESDAY, O WEDNESDAY, 1] *WEDNESDAY, O' EDNESDAY, OTHURSDAY,
Opening Business Workshop#1:The Workshop#2: Welcome Continental Annual Awards Presidents' Closing Brunch& �R
r,^ Session Value of Parks& Funding Munici- Reception Breakfast Luncheon Reception Business Session �s •
("a Recreation pal Government AIL
-
*This year's IACT Annual Awards Luncheon will have assigned seating.Only registrants who check the Annual Awards Luncheon above will be assigned a seat.We will do our best to
accommodate seating requests. Requests are not guaranteed.
Seating Requests:
Cancellation Policy
. Only written cancellations will be accepted. Please mail your written cancellation to 200 South Meridian Street, E-VERIFY
Suite 340,Indianapolis,IN 46225;fax to(317)237-6206 or send to kstorms @citiesandtowns.org. Written COMPLIANCE
received on or before September 18,will be refunded less a$40 processing fee. IACT is not
3 responsible for hotel reservations or cancellations. IACT is an enrolled
s^; Special Needs and Dietary Restrictions employer in the E-Verify
TACT will make the conference accessible to you. If you require special arrangements or a special diet,please Program verifying the work
notify IACT on your registration form. eligibility status of its new
Affiliate Group Events employees and will remain
y IACT affiliate groups may hold individual meetings and events at the conference. Attendees must be registered so until that program no
for the conference in order to attend affiliate events. Additional meeting and event information for affiliate group longer exists.
members may be mailed out separately.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
ota Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
1114� 1(0 40a��
��
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
20
d .
s
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund